Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | OS012280 | PA |
NPI | 1013961119 |
---|---|
Provider Name | Maria M Mountis |
First Address | Philadelphia, PA 19118-3169 |
Second Address | Philadelphia, PA 19118-3169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 11/06/2008 |